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  • CT Where pain lives

    https://aeon.co/essays/to-treat-back...6b3e4-69418129



    For patient after patient seeking to cure chronic back pain, the experience is years of frustration. Whether they strive to treat their aching muscles, bones and ligaments through physical therapy, massage or rounds of surgery, relief is often elusive – if the pain has not been made even worse. Now a new working hypothesis explains why: persistent back pain with no obvious mechanical source does not always result from tissue damage. Instead, that pain is generated by the central nervous system (CNS) and lives within the brain itself.

    I caught my first whiff of this news about eight years ago, when I was starting the research for a book about the back-pain industry. My interest was both personal and professional: I’d been dealing with a cranky lower back and hip for a couple of decades, and things were only getting worse. Over the years, I had tried most of what is called ‘conservative treatment’ such as physical therapy and injections. To date, it had been a deeply unsatisfying journey.

    Like most people, I was convinced that the problem was structural: something had gone wrong with my skeleton, and a surgeon could make it right. When a neuroscientist I was interviewing riffed on the classic lyric from My Fair Lady, intoning: ‘The reign of pain is mostly in the brain,’ I was not amused. I assumed that he meant that my pain was, somehow, not real. It was real, I assured him, pointing to the precise location, which was a full yard south of my cranium.

    Like practically everyone I knew with back pain, I wanted to have a spinal MRI, the imaging test that employs a 10-ft-wide donut-shaped magnet and radio waves to look at bones and soft tissues inside the body. When the radiologist’s note identified ‘degenerative disc disease’, a couple of herniated discs, and several bone spurs, I got the idea that my spine was on the verge of disintegrating, and needed the immediate attention of a spine surgeon, whom I hoped could shore up what was left of it.

    Months would pass before I understood that multiple studies, dating back to the early 1990s, evaluating the usefulness of spinal imaging, had shown that people who did not have even a hint of lower-back pain exhibited the same nasty artefacts as those who were incapacitated. Imaging could help rule outcertain conditions, including spinal tumours, infection, fractures and a condition called cauda equina syndrome, in which case the patient loses control of the bowel or bladder, but those diagnoses were very rare. In general, the correlation between symptoms and imaging was poor, and yet tens of thousands of spinal MRIs were ordered every year in the United States, the United Kingdom and Australia.

    Very often, the next stop was surgery. For certain conditions, such as a recently herniated disc that is pressing on a spinal nerve root, resulting in leg pain or numbness coupled with progressive weakness, or foot drop, a nerve decompression can relieve the pain. The problem is that all surgeries carry risks, and substantial time and effort is required for rehabilitation. After a year, studies show, the outcomes of patients who opt for surgery and those who don’t are approximately the same.
    Last edited by Jo Bowyer; 12-09-2017, 06:58 PM.
    Jo Bowyer
    Chartered Physiotherapist Registered Osteopath.
    "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

  • #2
    I have thought for some time that chronic pain should be re-classified as a mental illness. A lot of good could come from a wholesale upheaval and updating of classification and diagnostic criteria. Whilst mental illness still has an enormous stigma attached to it, this has changed quite a bit in the last 5 years and the momentum will probably continue. So as a society, we should be close to 'ready' for such an update.

    Chronic pain and anxiety/depression have so much in common. The overlap in symptoms is almost complete, and they respond to the same types of interventions (acceptance, anti-depressant medication, exercise, belief restructuring). There's also all the research to say that the mind's output is the single most dominant factor in chronic pain states. What more is needed? If a patient has a fracture, we don't classify it under 'infectious disease' and attempt to fix the issue with antibiotics. And yet this is what is currently happening with most pain patients. It's quite irresponsible.

    Last edited by EG-Physio; 13-09-2017, 03:54 AM.

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    • #3
      The science and philosophy of the meaning of pain

      By timcocks0noi, September 15, 2017

      https://noijam.com/2017/09/15/the-sc...aning-of-pain/

      existential-suffering.jpg?w=492&h=290.jpg
      Jo Bowyer
      Chartered Physiotherapist Registered Osteopath.
      "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

      Comment


      • marcel
        marcel commented
        Editing a comment
        "clinicians must be careful not to presume that chronic pain complaints that cannot be accounted for readily by physiological findings are due to psychiatric disorders"

        https://www.ncbi.nlm.nih.gov/books/NBK219250/

      • EG-Physio
        EG-Physio commented
        Editing a comment
        That statement in quotes reminds me of the old-fashioned 'organic' versus 'inorganic' labeling. Psychiatric disorders ARE physiology. You can't have a single negative thought without a chemical correlate. Rather than creating a false dichotomy, that author should be focusing on what comes first and what follows.

    • #4

      I totally agree.

      Work on gene expression, physiology and biochemistry is still in relatively early stages.
      Jo Bowyer
      Chartered Physiotherapist Registered Osteopath.
      "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

      Comment

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